Inside Health

Adolescent Care Enters Its Formative Years

By CAREY GOLDBERG

Published: June 22, 1997

SEATTLE—
YOU'RE a 16-year-old girl, and you've done something dumb. You've had impetuous, unprotected sex with a boy you don't know well, and now you're suffering symptoms that fill you with fear and dread -- fear that you have caught something and dread of the doctor's visit you know you have to make.

Just a few years ago, you would have had two equally unpalatable medical options: Go to your mother's gynecologist, almost always a man, or your family doctor, probably a man, risk his disapproval and beg him not to tell your parents.

But in 1997, if you are a teen-ager at Nathan Hale High School in Seattle, for example, your prospects are quite different.

If you come to the health clinic based in the school, ''they work with you,'' said Terisa Traylor, 15 and a 10th grader. ''You can tell them things about what happened instead of just, 'I had sex and I want to get tested.' And it really helps you come in, knowing there are women you can talk to about your problems.''

Terisa and other Seattle girls who were interviewed, most of whom echoed her views, were perhaps not conscious of it, but they were benefiting from a confluence of medical trends that some doctors think are improving the health care of teen-age girls around the country: the blossoming of adolescent medicine as a specialty; increasing access to clinics for women and teen-agers, and the large number of female doctors who have been entering the field.

Just in time, too. The old threats to teen-agers' lives and well-being -- polio and other infectious diseases and wartime service, among others -- are long gone. But surveys indicate that adolescent girls today are in particular need of improved care because they face a different set of threats: from their own behavior and the danger it entails in an era of AIDS, violence and rampant sexually transmitted diseases.

In earlier generations, girls tended to try drugs, alcohol and cigarettes at a later age and in fewer numbers than boys; that is no longer true. A recent study by the National Center on Addiction and Substance Abuse, for example, found that adolescent girls are slightly more likely than boys to smoke (about 12 percent do). The survey also found that girls today are just as likely as boys to drink (18 percent) and use illicit drugs (13 percent).

Rates of pregnancy and sexual activity among teen-age girls, despite a recent dip, remain near record levels. Girls also suffer disproportionately from eating disorders. Most disturbing, medical experts say, is that girls nowadays place themselves at risk for AIDS.

''Twenty-five years ago, if you were sexually active, the bad news was that you'd get pregnant,'' said Jeffrey E. Lindenbaum, a clinical professor of pediatrics at the University of Washington. ''Maybe you'd get herpes; it was unlikely but possible you'd get a sexually transmitted disease. None of those were the end of your life. Now, statistically, teens are one of the groups with the highest incidence of H.I.V., so in that sense they're more at risk.''

Experts cite the influence of popular culture, stress and peer pressure to explain why girls increasingly take these risks. In interviews, girls also evinced an ''everybody's doing it'' attitude -- a sense that in many circles it is quite normal to be sexually active in the 11th grade, to diet fanatically, to smoke.

Into the breach created by these behavior-borne risks has been stepping a new kind of practitioner, one who specializes in the maelstrom of hormones, confusion, doubt and danger that is adolescence, and who knows how to work in that world. And though no one appears to have counted the numbers, those in the field say the new specialists are disproportionately women -- as are new pediatricians, with women accounting for 61 percent of current pediatric residents. And that, practitioners say, is a boon for adolescent girls.

It is not that a sensitive, well-trained man cannot counsel or examine a teen-age girl just as well as a woman can, said Dr. Robert Masland, himself a grand old man of adolescent medicine and former chief of the adolescent clinic at Children's Hospital in Boston, one of the nation's first. But he and other adolescent specialists say that girls overwhelmingly prefer female doctors or nurses, particularly when they need a pelvic exam or to discuss anything gynecological, and that some girls are much likelier to seek treatment if they have that choice.

''If you're a competent, caring, kind, thoughtful human being, it shouldn't make a lot of difference if you're a man or a woman,'' said Dr. Masland, who estimates that of the specialists his clinic has trained over the last 26 years, 75 percent have been women. ''But I have to tip my hat to my women colleagues and agree there are certain individuals who need to see someone of their own gender.''

Indeed, he said, his clinic routinely asks girls if they want a female doctor, while it does not always ask boys if they want to see a man. Dr. Ann Giesel, a specialist in adolescent medicine and a clinical associate professor at the University of Washington, said that teen-age girls can be so resistant to having a man involved in their care that it can hinder training for male residents.